Diversity Issues, Challenges, & Opportunities in Health Care - - PowerPoint PPT Presentation

Diversity Issues, Challenges, & Opportunities in Health Care

Rani H. Srivastava RN, PhD Deputy Chief, Nursing Practice CAMH Rani_Srivastava@camh.net

• R. Srivastava, February 24, 2010

Greetings, I am pleased to see that we are different. May we together become greater than the sum of both

• f us

Vulcan Greeting, Star Trek

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Overview

Issues & Challenges

• Nature & Complexity of Cultural Diversity
• What gets in the way

Opportunities

• Principles & Approaches to move forward

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Embracing Diversity

Embracing diversity in the workplace means a commitment to culturally competent practices that eliminate discrimination and disparity, affirm differences, and actively engage in strategies that draw on the strength of the differences to develop innovative and transformative health strategies that maximize the health, economic and social benefits.

RNAO, 2007

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Most people want to embrace diversity, just not sure how to Understanding of diversity needs to shift from a Value Added to an Essential Ingredient

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So what gets in our way?

• Ethnocentrism
• Invisibility

– Discrimination and disparities are hard to see, hard to measure, and hard to account for

• Fears & Worries

– Sense of Inadequacy – Fear of offending / harming others – Desire for political correctness – Fear of looking foolish

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Ethnocentrism

The tendency to evaluate other groups according to the values and standards of

• ne's own ethnic group, especially with the

conviction that one's own ethnic group is superior to the other groups

Little tolerance, respect, understanding for people from “opposing” cultural points of view. People who see the world differently than they do are seen as being dangerous, misinformed, or less informed and even dangerous

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Difference in Worldviews The opposite of a correct statement is a false statement, but the opposite of a profound truth may well be another profound truth

Neils Bohr, Nobel prize winning physicist

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Some questions to consider …

• What difference does difference make?
• Which differences matter in which

circumstances? Cultural differences are not about right or wrong, true or false, superior or inferior, they are simply about being different.

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Dynamics of Difference

• Exist in every interaction - the

degree[s] of difference may vary

• When one culture interacts with the

population of another, both may misjudge the other’s actions based on learned expectations.

• Each party brings to the relationship

unique histories with the other group and the influence of the current political relationship between the two groups.

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Dynamics of Difference

• Both bring culturally-prescribed patterns of

communication, etiquette, and problem

• solving. Both may bring stereotypes or

underlying feeling about serving—or being served by—someone who is “different.”

• Although both professionals and clients

should be vigilant against misinterpretation and mis-judgment, look to see who is in the position of privilege and dominance.

.

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Key Messages from the Literature

• Culture matters & plays a significant role in

health, illness, care and cure.

• Culture of the clinician and the health care

system also affects diagnosis, treatment and availability of services.

• Leadership matters & plays a significant role

in influencing the extent to which diversity initiatives are successful

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Why does culture matter?

• Culture as Patterns

– Differences in worldviews (values, beliefs, assumptions)

• Culture as Power

– Some worldviews are privileged and others are marginalized

• Differences in recognition of needs and

issues

• Differences in access to resources

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What do we mean by culture?

• Identity(ies)
• Relationships between identities
• Layers
• Legacies

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Cultural Identity

...formed by the unique combination of several Petals! The unique combinations create patterns which reflect the Diversity and Universality of Culture. Culture Culture Race S

• c

i a l / P r

• f

e s s i

• n

a l S t a t u s L a n g u a g e Lifestyle Gender S

• c

i

• e

c

• n
• m

i c S t a t u s

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Legacies & Layers:

Legacies: Events and traditions experienced by

• ur ancestors that continue to have a

ripple effect in our lives / practice today. Layers: Various dimensions of our identity and experiences that shape perception and behavior

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• ALL other persons
• Some other persons
• No other person

Each person is to some extent like

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Culture is multi-level…

Culture is an aggregate construct which is a reflection of /consists of:

• Multiple identities at an individual level
• Actions and Interactions at a group level
• Assumptions / policies / politics at an
• rganizational or systems level

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Levels of Cultural Competence

Individual (Micro) Organizational

LHIN

TEAM PROCESSES TEAM CULTURE

Critical to Focus on the Meso / Middle level

(MESO) (Macro)

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What is the roadmap for change?

• No roadmap
• Principles and approaches
• Chart a course:

– Set Goals – Measure Progress – Look out for intended and unintended effects

• Take Action & Monitor

– Promising practices – Measure (Quantitative & Qualitative), share, reflect

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Key Values for Embracing Diversity

• Inclusivity
• Respect
• Valuing differences
• Equity
• Commitment

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What are the motivators?

• Mission -

this is what we are about

• Meeting the needs of patients -

patient satisfaction

• Quality and safety issue
• Supporting our staff
• Market niche –

provider of choice

• Good business sense
• Requirement for …???
• Is there a need for standards?

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Where is the evidence?

• Inconsistent but considerable…
• RNAO Guidelines on Embracing Diversity:

Developing Cultural Competence (2007) www.rnao.org

• Hospitals, Language, and Culture: A

Snapshot of the Nation Exploring Cultural and Linguistic Services in the Nation’s Hospitals (Joint Commission / California Endowment, 2007) One Size Does Not Fit

• All. www.jointcommission.org

www.jointcommission.org

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Where is the evidence?

• Evidence that culture matters with respect to

health disparities

• Negative evidence –

lack of cultural competence leads to threats to patient safety / health disparities; legislative non- compliance; exposure to risk /liability

• Challenges in measurement make it difficult

to gather evidence

• Lack of evidence does not equal

ineffectiveness

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Approaches & Promising Practices

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Culture Care Framework

Srivastava, 2007

Culture Sensitivity Culture Resources Culture Knowledge

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Culturally Congruent Care Equity in Health Care Quality & Outcomes

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Knowledge

Quadripartite Framework

Skills Awareness Power

EQUITY

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Shift from viewing culture as a barrier to culture as a leverage point Clarify links to goal:

EQUITY, QUALITY, SAFETY

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Seeing beyond …

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Systems & Systematic Change

• Move beyond acknowledging &

celebrating diversity towards meaningful change

• Cultural competence is not about

adjustment to cultural differences and keeping the system unchanged

• Access is not the answer!

– Focus on what the underserved populations/groups need NOT what we have to give

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Systems & Systematic Change

• Education & Training

– All levels of health care providers – Focus not just on awareness but also knowledge, skills, and most importantly - APPLICATION

• Measure & Monitor (the need for DATA!)
• Capacity building
• In practice, community, & leadership
• Through education, recruitment, mentorship

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Be Courageous…

• Challenge own thinking and assumptions
• Be Vulnerable
• Create Safe spaces for dialogue
• Take Risks … Be prepared for mistakes
• Have difficult conversations
• Commitment is critical – not doing it is

not an option!

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Each one of us must be the Each one of us must be the change we want to see in the change we want to see in the world world

Gandhi Gandhi

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Key References

Srivastava, R. (2007) The Healthcare Providers Guide to Clinical Cultural

• Competence. Toronto: Elsevier

RNAO (2007). HWE Best Practice Guidelines Embracing Cultural Diversity in Health Care: Developing Cultural Competence. Available from www.rnao.org

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THANK YOU!

Comments….. Questions?! Rani_Srivastava@camh.net